Manual Therapy Provides Insight into The Patient’s Body

As Rehab professionals we help our patients by listening to them, allowing them space to hear their body's wisdom, and educating them on how their bodies work. When it comes to educating people about their bodies, we often use pictures, models, and verbal explanations of movement and function. In addition, one of the best ways we can teach them about how they move is by actually touching them. By allowing them to learn where they are holding greater tone or how to move in a different way, we give them insight into their body and give them a way to move forward in their recovery.

Manual therapy is a modality that we can utilize to help a patient become aware of a part of their body that they did not realize they had the ability to control or change. Take the example of living next to an airport – after a while we may not hear the planes anymore – now take this example to our bodies. Many of us, including our patients, are not aware of the way we hold our bodies. We are unaware that we are holding increased tension in our body and that we have the ability to control the muscle activity of our body. By using manual therapy, we help the patient gain access to the part of their body and help them learn how to manage or change that part of their body.

Fascia is defined as “a three-dimensional continuum of connective tissues present everywhere throughout the body, from the head to the toes and from the skin to the bone.” ^{1, 2} When reading about the attachments of the abdominal fascia we learn that there are connections from the abdomen to the breathing diaphragm, the pelvic floor region, and the lateral hip.^{3, 4} By addressing the abdominal wall superficial fascia, deep fascia, and abdominal muscles we can also assist these other areas of the body. Improving breathing, trunk mobility, the pelvic girdle, and the function of the genitourinary and gastrointestinal systems to name a few.

With our trained Rehab eye, we often see that folks have developed patterns of movement that are not beneficial for the way they need to function in their lives. We as humans really cannot see ourselves and may not be aware of how we are moving, how we might be bracing, protecting, or limiting movement. In pelvic rehab, if a patient has IC/PBS, endometriosis, dysmenorrhea, or has had an abdominal surgery they may unknowingly hold their abdominal myofascial tissues in a way that limits their movement for bending, reaching, and lifting. If those tissues have greater tone or restriction, they may limit the power the muscles can generate, or the coordination needed to assist with bowel movements or relaxation needed for insertion into a canal for intimacy or exam.

As Rehab professionals we have learned some basic interventions to address the myofascial tissues of the body, but when it comes to applying those techniques to the abdominal wall we sometimes are at a loss about how and when it is safe to touch the abdominal wall. In this one-day course, Manual Therapy for the Abdominal Wall, we take the skills we learned to address the myofascia in the leg, neck, and back and apply them to the abdominal wall. We discuss precautions, things to consider/monitor and discuss how to touch. By connecting in this way, the patient is then able to become aware and you as the therapist can help them improve their movement and improve their function.

• This class has no prerequisites and while it is a beginner class, it has been appreciated by the experienced pelvic health provider wanting to review basic myofascial techniques application to the abdominal wall.
• This class was developed as a way for folks to hone their manual skills by applying them to the abdominal wall and then you can take those techniques and connect them to the perineum and the thorax. We utilize lectures, videos, and practice in this course.

Join me on the April 27th or October 20th to take your skills to the next level!

Resources:

1. Kirchgesner, T., Demondion, X., Stoenoiu, M. et al. Fasciae of the musculoskeletal system: normal anatomy and MR patterns of involvement in autoimmune diseases. Insights Imaging 9, 761–771 (2018). https://doi.org/10.1007/s13244-018-0650-1
2. Adstrum, S., Hedley, G., Schleip, R., Stecco, C., & Yucesoy, C. A. (2017). Defining the fascial system. Journal of bodywork and movement therapies, 21(1), 173-177.
3. Stecco, C. (2020). Fascial Anatomy. In Fascia, Function, and Medical Applications (pp. 19-30). CRC Press.
4. American Osteopathic Association. (2010). Foundations of osteopathic medicine. A. G. Chila (Ed.). Lippincott Williams & Wilkins

COURSE TESTIMONIALS:

• “This class was fantastic. It covered many immediately applicable tools that can be used on a wide range of patients in the clinic. I really liked the videos of assessment and intervention that Tina provided, as well.”
• “The course was wonderful Tina was extremely kind and generous with her knowledge and feedback, taking time for questions even if it meant not taking a break herself. The videos were super helpful, as is the manual. Thank you so much!”
• “It was a great course and instructor is very knowledgeable.”
• “Great mix of anatomy review and then applying the concepts to patient care.”

AUTHOR BIO:

Tina Allen, PT, BCB-PMD, PRPCTina Allen, PT, BCB-PMD, PRPC has been a physical therapist since 1993. She received her PT degree from the University of Illinois at Chicago. Her initial five years in practice focused on acute care, trauma, and outpatient orthopedic physical therapy at Loyola Medical Center in Illinois. Tina moved to Seattle in 1997 and focused her practice in Pelvic Health. Since then she has focused her treatment on the care of all genders throughout their life spans with bladder/bowel dysfunction, pelvic pain syndromes, pregnancy/ postpartum, lymphedema, and cancer recovery.